CIVIC EDUCATION PROJECT • NORTHWESTERN UNIVERSITY

CivicWeek
Summer 2008
for Jack Kent Cooke Foundation Young Scholars

Application Form

Instructions

1. Review all the information available on the CivicWeek program pages (click to review program information) then complete the fields below and submit your registration at the bottom of this page. Fields marked with a * are required.

2. Before you begin your application, be aware that all applicants are required to submit a short essay explaining why they want they want to attend CivicWeek and what they hope to gain from the experience. You may wish to write your essay before starting to complete the online application form. If you experience difficulty completing your essay below, you can also submit the essay by e-mail to cep@northwestern.edu either as the message body or as a Microsoft Word (.doc), Portable Document Format (.pdf), or text (.txt or .rtf) attachment.

3. Students will be notified by mail on or around April 1, 2008 regarding the status of their application. Accepted students receive an admissions packet at that time, with all relevant information about the program, including a detailed schedule, travel information, things to bring, program rules and policies, etc.

4. Applications received after the March 21, 2008 deadline will only be considered as space permits.

Thank you for your interest in the Civic Education Project's CivicWeek for Jack Kent Cooke Young Scholars program. With questions about the program, to check on the status of your application, or if you are experiencing difficulties with the online application, please contact us at (847) 467-2572 or cep@northwestern.edu.

STUDENT INFORMATION


Middle Name *
       
Date of Birth*
/
/
 
MM
DD
YYYY
  
           
Mailing Address*
  Number and Street Address
 
  City State Zip
       
Home Phone*  Cell Phone E-Mail* 
     
Gender*    Female    Male

 

PARENT CONTACT INFORMATION

Parent/Guardian 1  
First Name*
*
     
Mailing Address
(if different) Number and Street Address
 
  City State Zip
       
Day Phone* Evening Phone*  Cell Phone
     
Email  
     
   
Parent/Guardian 2  
     
Mailing Address
(if different) Number and Street Address
 
  City State Zip
       
Day Phone Evening Phone Cell Phone
     
Email  
     

 

PROGRAM HISTORY

Have you previously participated in a program of the Civic Education Project or the Center for Talent Development?*
   Yes
   No
Which Program? Last Year Attended
     
 
How did you first hear about CivicWeek?*
 
Note


ACADEMIC INFORMATION

Current School
  Name* City* State*
Grade Year *    
(for the 2007-2008 academic year)    


PROGRAM PREFERENCE

Please indicate the program(s) for which you are applying. If you are available to and interested in attending more than one program option, please select further program preferences.
 
Top Choice* 
Second Choice 
Third Choice


STUDENT ESSAY

Please submit an essay of approximately 250 words (1 printed page), completely conceived of and written by the applicant, describing his/her reasons for wanting to attend CivicWeek, and what he/she hopes to gain from participating in the program.

It may be easier to type your essay in another word processor (like Microsoft Word) so you can save and review your writing, then copy and paste it in the space provided.

If you experience difficulty completing your essay below, you can also submit the essay by e-mail to cep@northwestern.edu either as the message body or as a Microsoft Word (.doc), Portable Document Format (.pdf), or text (.txt or .rtf) attachment.
 


STUDENT HONOR CODE

The Civic Education Project takes every reasonable step to ensure the safety of our students and staff. However, students must willingly follow certain guidelines to contribute to a safe working and learning environment. We ask that students act responsibly and maturely at all times, and follow a strict code for student conduct. In order to create a safe and successful learning community, I agree to:

• Attend all CivicWeek activities, be on time, and participate fully
• Always act with honesty and personal integrity
• Treat all students, staff, and community members with respect, regardless of their race, culture, religion, age, gender, ability, or sexual orientation
• Treat all facilities and property with respect and care
• Observe all program rules and cooperate with staff

I understand that if I fail to live up to these expectations for behavior, I may be dismissed from the program, and sent home at my own expense. Infractions that may result in dismissal from the program are detailed in the Student Handbook.


CERTIFICATION

We have read the CivicWeek brochure and fully understand the nature of the program, admission criteria, refund, and financial aid policies. We agree to abide by the rules and policies stated in this brochure, in the student handbook, and established during the session by staff. As a parent/guardian, I give permission for my child to participate in CivicWeek and all related activities and field trips. As a student, I give CivicWeek representatives permission to contact my parent(s), guardian(s), and/or emergency contact(s) to discuss academic, health, administrative, or disciplinary matters related to my enrollment in the program. The signatures below also grant Northwestern University the right to reproduce the student’s image, likeness, or student work in public relations publications and other media. We will make no monetary or other claim against Northwestern for such use. We certify that all statements and materials presented in the application process are correct and complete, and agree that the knowing submission of inaccurate, incomplete, or misleading statements or materials constitutes grounds for revocation of admission or dismissal from the program.

Both a parent/guardian and the student applicant must type their name and the current date below to certify the above statement.
     
Certified by:
  Student Full Name* Date*
     
Certified by:
  Parent/Guardian Full Name*  Date*
     

Completing Your Application

Please Note: When you click on the "Confirm Application" button below, your completed Application for Admission will be sent via email to cep@northwestern.edu, and a screen confirming the information you submitted will appear. If you need to revise or edit any parts of your application after sending, please contact CEP at (847) 467-2572 or cep@northwestern.edu.

Civic Education Project
617 Dartmouth Place, Evanston, Illinois, 60208-4175
Phone: (847) 467-2572, Fax (847) 491-3394, E-mail: cep@northwestern.edu